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Treatment decisions for high-risk prostate cancer
We talk about high-risk prostate cancer in cases involving tumour category cT2c, a Gleason score of 8 or above and a PSA level above 20 ng/ml. However, even if we classify your cancer as high risk, you still have good treatment options available to you, as outlined on this page. These values determine your risk group and, when considered alongside your age and general health status, lead to different treatment recommendations.
Radical prostatectomy
Studies have shown that patients with high-risk tumours benefit most from radical prostatectomy (RPE). This operation can be recommended for all patients whose estimated remaining life expectancy is more than ten years.
Radiotherapy
Radiotherapy can be administered either instead of surgery or following surgery. Adjuvant (supplementary) radiotherapy is indicated when there is a positive surgical margin or prostate capsule involvement, as these cases entail a high risk of the cancer returning (relapse). Radiotherapy can reduce the risk of relapse. Radiotherapy alone may be an option for patients with localised tumours with an intermediate or high risk profile. Radiotherapy administered externally (percutaneously) can be supplemented with HDR brachytherapy.
HDR brachytherapy
Brachytherapy is a form of internal radiotherapy. It can be administered as low-dose rate (LDR) or high-dose rate (HDR) brachytherapy. HDR brachytherapy involves temporary implantation of a high-dose radiation source and can be used against moderately and highly aggressive tumours. In HDR brachytherapy, a radiation source is implanted under anaesthetic and then removed a few minutes later. This procedure is repeated one week later and is usually accompanied by percutaneous radiotherapy.
Drug therapy
If you do not wish to undergo surgery or radiotherapy, or are unable to do so, hormone therapy may be an option if your PSA level is below 50 ng/ml and doubles within a year. Hormone therapy can also be provided as an adjuvant, supporting option either before (neoadjuvant), during or after radiotherapy or surgery.
Lymph node removal
In the case of a relapse, when metastases appear in the lymph nodes or soft tissue, removing these metastases at an early stage can postpone the need for hormone therapy or radiotherapy. In some cases, it can eliminate the need for follow-up treatment altogether, which is an immense relief for the patients in question.
Treatment decisions when prostate cancer is detected early
Treatment decisions for intermediate-risk prostate cancer
What treatment options are available for high-risk prostate cancer?
We talk about high-risk prostate cancer in cases involving tumour category cT2c, a Gleason score of 8 or above and a PSA level above 20 ng/ml.
However, even if we classify your cancer as high risk, you still have good treatment options available to you. Studies show that patients with high-risk tumours benefit most from surgical removal of the prostate (prostatectomy). This is a first-line treatment option for patients with clinically localised prostate carcinoma in all risk groups. Radiotherapy can be administered either instead of surgery or following surgery. It can be supplemented by HDR brachytherapy. Hormone therapy can be administered on its own or as a supporting option before, during or after radiotherapy or surgery.